Two legacies of caring. 

One ministry of change. 

CommonSpirit was created by the alignment of Catholic Health Initiatives and Dignity Health as a single ministry in early 2019.  More than 150,000 physicians, nurses, caregivers, and other staff are employed by CommonSpirit  Our hospitals and care centers cover 21 states.  CommonSpirit has the size and ability to scale best-in-class clinical service lines; recruit and retain top talent; standardize operations to improve quality and reduce the cost of care; and advocate more effectively for all people, especially those who are poor and vulnerable. For more information, please visit our website at www.commonspirithealth.org. You can also follow us on Twitter and Facebook.

Job Summary / Purpose

Responsibility/accountability for dual areas within COMMONSPIRIT HEALTH acute care coordination. These areas are denials management and clinical compliance audits, which address revenue integrity as well as auditing activities, analyzing findings, identifying areas of risk, and recommending interventions based on audit results as it relates to compliance with industry standards. This position will lead development and implementation of processes and projects to achieve operational efficiencies through coordination of systems and programs focused on system strategies, performance improvement, and increased organizational effectiveness. Accountable for standardizing policies, practices, work flow, utilization management, and data reporting within the system. Partner with system and division leaders to ensure quality patient care and adherence to all relevant compliance activities.

Essential Key Job Responsibilities

• Develop strategy and process in conjunction with Physician Advisors, revenue cycle leaders and other key stakeholders at both local, divisional and national levels to optimize denial prevention processes and create pre-bill and post-bill solutions.
• Reviews, prepares, analyzes, and presents reports and recommendations to senior management regarding operations and/or other applicable areas of interest in order to provide concise and accurate information that aids in decision-making. Develops, reviews, and monitors clinical, service and financial outcomes using performance metrics.
• Responsibility and oversight of Medical Necessity Support Center (MNSC) overall operations.
• Participates in activities that promote professional growth and development and maintains current knowledge base in all areas of responsibility
• Keeps abreast of current legal, accreditation, and regulatory requirements and applying into relevant standards and appropriate policies and procedures for CCRS and licensed staff.
• Identifies areas for audit opportunities based on industry performance, regulatory focus areas and risk areas within the organization.
• Develop, implement and track improvement strategies and implement appropriate intervention in response to analytics, risk assessments, audit findings (both internal and external), and reported potential non-compliance, by developing meaningful improvement work plans executed within expected timeframes, to include administration, recommendation and/or coordination of auditing and monitoring, policy revision, training, and corrective action plans as appropriate.
• Employee may be required to perform other duties as assigned.

Required Education and Experience

• Master's degree or equivalent education / experience in nursing or healthcare/business related field.
• Ten or more (10+) years of related work experience in a leadership role in an acute care setting / system experience preferred

Required Licensure and Certifications

• RN with CCM or ACM preferred